First Lady Begins Radiation for Eye Condition : Health: Medication fails to relieve painful swelling caused by thyroid disorder. The next step could be surgery.

WASHINGTON — First Lady Barbara Bush, suffering from persistent double vision and swelling around her eyes, began 10 days of daily radiation treatments Wednesday to relieve the symptoms of a thyroid condition known as Graves' disease.

The painful inflammation, which causes excessive tearing and discomfort, was first noticed a year ago about the time President Bush was inaugurated. Physicians since have attempted to treat it with medication.

If the low-level radiation treatments at Walter Reed Army Medical Center do not produce better results, experts said, the next line of attack could include surgery.

Over the last year, the White House has portrayed the condition as relatively minor and temporary. Mrs. Bush, 64, has maintained a full agenda of public appearances, carrying out a schedule with no suggestion that the condition has forced her to curtail her activities.

The move to the radiation treatments, however, suggests that she is finding it more difficult to shrug off the problem.

"If one looks at a large number of patients with Graves' Disease, the proportion of patients who have major difficulties with this kind of ocular problem is really pretty small," said Dr. Robert Utiger, an endocrinologist formerly associated with the University of North Carolina department of medicine and now deputy editor of the New England Journal of Medicine.

Mrs. Bush spent several hours at the hospital in Washington Wednesday, undergoing pretreatment tests and the first 10-minute radiation treatment. Upon returning to the White House, she visited briefly with the President and then completed her customary one-mile swim in the heated, outdoor pool on the White House grounds, her press secretary said.

"It was like going to the dentist, except better," Mrs. Bush said after the treatment, according to Press Secretary Anna Perez.

The thyroid condition for which Mrs. Bush is being treated was named after Robert Graves, a 19th-Century Irish physician who first described it. It is caused when the body's immune system attacks parts of the body itself. The primary targets are cells in the thyroid gland, a small, butterfly-shaped gland in the neck, and in the small muscles that control the movement of the eyes in their sockets.

Mrs. Bush underwent treatment with radioactive iodine on April 12 to destroy the thyroid gland, which was producing excess amounts of hormones. Among the symptoms were the ocular irritation and a 21-pound weight loss over a period of several months.

Subsequently, she began treatments with a drug known as prednisone, a powerful steroid in the cortisone family. But despite upbeat reports, it appeared that Mrs. Bush's eyes--given a bulging appearance by the swelling--were not responding satisfactorily to the medication. On Nov. 29, she visited the Mayo Clinic in Rochester, Minn., for further examination.

The radiation treatment, which was begun Wednesday at Walter Reed, has been used for many years.

It is "a sort of second-line treatment," Utiger said. "It's not one that is usually done initially or in a patient who has had a favorable response to prednisone."

The success rate is "a matter of some controversy," he said, and the medical literature has shown that it has produced mixed results.

"The alternative is a surgical procedure," Utiger said. Under one operation, bits of bone that form the cup in which the eye sits are removed, to provide more room for the swollen tissue.

Perez said that the prednisone had served its primary purpose--to stabilize the symptoms--and that the condition is not getting any worse.

"Doctors do not look at prednisone as a long-term therapy," she said, adding that it is hoped that Mrs. Bush can be weaned from the drug, administered in a pill, when her radiation treatments end.

Perez, as well as endocrinologists, said that no physical side effects from the radiation are expected.

Utiger said that the dosage is considerably smaller, and more targeted, than the radiation commonly administered for treatment of brain tumors or cancers in various organs and is not likely to produce the fatigue, nausea or hair loss associated with such therapy.

However, he said that care must be taken in irradiating the tissue behind the eye so that the lens and cornea will not be damaged.

When she visited the Mayo Clinic, Mrs. Bush told a reporter who asked how she felt: "Listen, I could wrestle you to the ground. Nobody feels any better than I do."